On the 20th anniversary of the law that revolutionized health insurance in Massachusetts, political leaders and health officials sounded the alarm that affordable and accessible coverage is in peril.
“We face a cost crisis,’’ Governor Maura Healey said at a Faneuil Hall ceremony on Monday marking Romneycare’s anniversary. “Our nation’s health care system is broken, and Washington’s not going to fix it, certainly not anytime soon. And that’s a revolution I think we need to lead again, right here from Massachusetts.’’
The Trump administration is instituting limits on federal health insurance subsidies and on who qualifies for financial aid. Additionally, rising costs for insurance users and the employers who help pay for their policies are making health care harder to access.
The result, health care officials said in interviews, is Massachusetts’ near-universal health insurance coverage is at stake.
Yet Monday’s event was also about celebrating Romneycare. Former governors Deval Patrick, Bill Weld, Michael Dukakis, and Mitt Romney joined Healey at Faneuil Hall, where the law was signed two decades ago.
“Health care reform 20 years ago was neither perfect nor unanimous. But it has helped millions of people — first in the Commonwealth and eventually across the country — lead healthier lives,’’ Patrick, who served as governor from 2007 to 2015, said in a statement.
About 22,000 people terminated their coverage through the Health Connector this year after certain tax credit enhancements expired, causing premiums to skyrocket for some low and middle-income families who purchased their own insurance through the exchange, said Health Connector executive director Audrey Morse Gasteier in an interview. That’s double the number who canceled their plans in previous years,
Additionally, President Trump’s One Big Beautiful Bill Act that passed in July took away insurance subsidies for lawfully present immigrants. About 30,000 people in Massachusetts lost coverage because of the policy, Gasteier said.
“Being reminded that Massachusetts can do hard things and that people can do hard things is really needed,’’ Gasteier said. “The challenges we face are actually even greater than those we faced in 2006. It’s a steep hill ahead.’’
The state certainly has a history of health care transformation. In 2006, Romneycare, also known as Chapter 58, created the first state health insurance marketplace, required adults to carry health insurance, and required larger employers to offer insurance policies. Around 400,000 previously uninsured Massachusetts residents got coverage because of the reforms. The state’s insured rate is now 98 percent. In 2006, 6.4 percent of residents lacked health insurance, according to a Blue Cross Blue Shield of Massachusetts Foundation report.
The legislation served as the blueprint for Obamacare, the federal policy that extended health insurance to more Americans. Under a slew of recent federal cuts, users of either program are at risk.
Health care costs have also ballooned in the last 20 years, especially after the pandemic, affecting the budgets of employers, municipalities, and households. From 2023 to 2024, total health care expenditures per person in Massachusetts increased 5.7 percent. That’s the fourth year in a row the state exceeded the benchmark officials have set for the rate at which those costs should grow, which was 3.6 percent, according to analysis by the state’s Center for Health Information Analysis.
Both employers and employees are feeling the burden. Small- and mid-size employers had premiums reach an average of $685 and $697 per member per month, respectively, according to the analysis.
During a recent hearing on health cost trends, Retailers Association of Massachusetts president Jon Hurst said small businesses are suffering under the individual health insurance mandate, a pillar of Romneycare.
“As we have stated for many years, small employers need fairness and help on controlling health care and insurance costs,’’ Hurst said in written testimony.
At Faneuil Hall, banners declared the same sentiment as signs at the law’s signing: “Making History in Healthcare.’’ Nearly all of the former political leaders who spoke at Faneuil Hall said their parts in passing and implementing Romneycare were the pinnacles of their terms.
“We did a lot of things in that short period of time,’’ said Robert Travaglini, who served as president of the Massachusetts Senate from 2003 to 2007. “[Health care reform] is, without a doubt, the crowning jewel for me politically.’’
Romney, who served as governor from 2003 to 2007, said during the ceremony that passing health reform was only possible because politicians from across the ideological spectrum were willing to bury old disagreements and the pressure for reelection.
“Now having spent six years in Washington, I have a greater appreciation for what we did here,’’ said Romney, who served as senator from Utah from 2019 through 2025.
Looking ahead to the next 20 years, health care leaders and advocates worry about a growing number of uninsured people. In addition to cost increases and subsidy reductions, more than 200,000 low-income Massachusetts residents are expected to lose coverage through MassHealth, the state’s Medicaid insurance, in the next few years because of federal changes.
Health advocacy groups including Health Care For All are ramping up efforts to limit the number of people who are kicked off the insurance for procedural reasons, Suzanne Curry, the organization’s director of policy initiatives said in an interview.
Curry said Massachusetts is still one of the best-prepared states to handle the upcoming uncertainty.
“I’m feeling really good and really happy that I’m in Massachusetts,’’ she said. “We have had a consistent dedication and commitment from leaders through different administrations, through different legislatures, to maintain health coverage.’’